Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy.
Department of Gynecologic Oncology, Gemelli Molise, Campobasso, Italy.
J Cancer Res Clin Oncol. 2023 Aug;149(9):6479-6488. doi: 10.1007/s00432-023-04594-5. Epub 2023 Feb 11.
Uterine carcinosarcomas (UCSs) are aggressive biphasic malignancies, with a carcinomatous/epithelial component and a sarcomatous/mesenchymal counterpart. The aim of this study was to evaluate the impact of the sarcomatous component (homologous vs heterologous) on the overall survival (OS) and progression-free survival (PFS).
This is a multicenter observational retrospective study conducted in patients with stage I and II UCSs.
Ninety-five women with histological diagnosis of early-stage UCSs were retrieved: 60 (63.2%) had tumors with homologous sarcomatous components, and 35 (36.8%) with heterologous. At univariate analysis, a stromal invasion ≥ 50%, the presence of clear cell, serous or undifferentiated carcinomatous component, the heterologous sarcomatous component and FIGO stage IB and II were shown to be variables with a statistically significant negative impact on PFS. Similarly, a depth of invasion ≥ 50%, the heterologous sarcomatous component and FIGO stage IB and II were statistically negative prognostic factors also concerning OS. At multivariate analysis, only the heterologous sarcomatous component was confirmed to be a statistically significant negative prognostic factor both on PFS (HR 2.362, 95% CI 1.207-4.623, p value = 0.012) and on OS (HR 1.950, 95% CI 1.032-3.684, p = 0.040).
Carcinomatous and sarcomatous components both played a role in tumor progression and patients' survival. However, only the sarcomatous component retained a statistical significance at the multivariable model suggesting its preeminent prognostic role in early-stage UCSs.
子宫癌肉瘤（UCS）是一种侵袭性的双相恶性肿瘤，具有癌性/上皮成分和肉瘤/间叶成分。本研究旨在评估肉瘤成分（同源与异源）对总生存（OS）和无进展生存（PFS）的影响。
这是一项在 I 期和 II 期 UCS 患者中进行的多中心观察性回顾性研究。
共检索到 95 例经组织学诊断为早期 UCS 的女性患者：60 例（63.2%）肿瘤具有同源性肉瘤成分，35 例（36.8%）具有异源性肉瘤成分。单因素分析显示，间质浸润≥50%、存在透明细胞、浆液性或未分化癌性成分、异源性肉瘤成分以及 FIGO 分期 IB 和 II 期与 PFS 具有统计学显著的负相关。同样，浸润深度≥50%、异源性肉瘤成分和 FIGO 分期 IB 和 II 期也是 OS 的统计学负预后因素。多因素分析仅证实异源性肉瘤成分是 PFS（HR 2.362，95%CI 1.207-4.623，p 值=0.012）和 OS（HR 1.950，95%CI 1.032-3.684，p=0.040）的统计学显著负预后因素。
癌性和肉瘤性成分都在肿瘤进展和患者生存中发挥作用。然而，只有肉瘤成分在多变量模型中具有统计学意义，提示其在早期 UCS 中具有突出的预后作用。
